Direct Access Electronic Aids to Daily Living
Electronic aids to daily living, or EADLs, provide alternative access to electrical devices in the environment, such as audiovisual equipment, lights, doors, phones, and beds. This area of assistive technology used to be known as environmental controls, but the name was changed to more accurately define the area and to improve funding and reimbursement.
Direct access typically means pressing a button or key with a finger, as on a remote control for a television. Splinting may facilitate finger isolation and stability for access. Some clients can get their hand over a specific key, but they (often the hand remains fisted). They may be able to hold a pointer or use a splint that has a pointer attached. Direct access can also be achieved with mouth sticks or head and chin pointers.
Most direct-access EADLs were not specifically designed for persons with disabilities but rather as convenience items for the general population. As a result, this equipment is inexpensive and easily obtained.
Direct-access EADLs require fairly good fine motor skills. Clients who can benefit from this technology include those with mobility impairments, muscle weakness, and fatigue. Think about it. When you are at home sick with the flu, using the remote control from the couch becomes more than a convenience. You need to conserve your strength. People who often use direct-access EADLs include those with spinal cord injury (Below C-6-C-7), multiple sclerosis, arthritis, stroke, muscular dystrophy, and mild to moderate cerebral palsy. If the client has a progressive disorder, direct-access EADLs may be an inexpensive stepping stone toward more sophisticated systems that offer alternative access.
To better examine direct access EADLs, we will explore categories of the devices being controlled.
Most televisions (TVs), videocassette recorders (VCRs), and even stereos include remote controls. A remote sends an infrared signal to the device to control a specific feature, such as power, channel selection, or volume. Infrared signals have to be in line of sight, meaning you have to be in the same room and aim at what you are controlling. A variety of remotes are available. Some styles have very large and/or illuminated buttons. Other styles have very few buttons, which reduces choices (so they are cognitively more simple) and presents less to attend to visually. Universal remotes combine features of several devices, such as the TV and VCR, into one. Many of these remotes are available at large electronic stores and through Home Automation.
Remote infrared control has recently made audio equipment more accessible. These remote controls usually do not include all of the audio commands. For example, the remote may turn on the power and change tracks for the compact disc (CD), but not change the radio station. Always check to see whether the remote includes the features your client wants to control. CDs have also revolutionized audio control for persons with disabilities. Only about 20 to 30 minutes of music is available to persons who cannot turn over records and audio cassettes. Many stereos can play multiple CDs, allowing the client to choose from several albums and to even play specific tracks (songs) on those albums.
Lights and Appliances
X-10 is a company that took the remote control idea a step further to include on and off (and bright and dim) control of lights. They developed a remote control pad that sends radio signals to a receiver that plugs into a standard electrical outlet. This receiver then sends signals over the wiring in the home, looking for a module to turn on or off. For example, to control a table lamp in the living room by remote control, you can plug the lamp into a module (a small 2"x2" box) which in turn plugs into the wall outlet. Each module is assigned a number. Pressing button #1 on the X-10 remote control activates module #1. This company took laziness seriously when they made a waterproof floating cover to let you control your lights from the hot tub! Of course, it took an occupational therapist to discover that this waterproof cover reduces the activation pressure of the buttons and protects against saliva, as well.
Radio signals go through walls and ceilings, but they are subject to interference. Interference can result in modules being activated by outside radio signals or the X-10 radio signals triggering devices other than the intended module (like the neighbor's garage door!). X-10 technology offers 16 distinct channels, or House Codes, that can be changed if interference is an issue on one or more frequencies.
Modules can turn other devices on and off besides the lights. Appliances such as fans, blenders, and tape players can be controlled as well. I work with kids, and they always come up with the best and most creative things to control, such as electric train sets, Christmas tree lights, and tornado lamps. These modules function as though the device were being plugged in and out of the wall, so the controlled device needs to have a mechanical switch that can remain in the "on" position. For example, pressing down on a mechanical switch for "play" on a tape player into an outlet will result in the tape starting. If the tape player has an electrical switch (requiring electricity to activate), the tape will not start after being plugged in, but requires the play switch to be pressed while the power is on. Never plug a TV into a module! This will damage many sets because the module mimics the activity of repeatedly plugging that TV in and out.
Universal Modules include an alert signal that can be activated to get someone's attention in the home, as needed.
X-10 technology also controls thermostats and air conditioners. The Home Automation catalog features the full X-10 product line, which includes "automating" sprinkler systems, pet feeders, pet doors, and security features.
Directly accessing a telephone may not require any adaptations besides placing the phone within reach. To ease fine motor requirements, try a large-button telephone. To reduce effort, use a phone with speed/memory dial to reduce button hits and use speaker phones and wireless headsets so that the client doesn't have to sustain a hold on the receiver. Cordless and cellular phones can stay and move with clients, so reduced mobility is not an issue.
Most door openers offer a variety of remote controls that are either radio or infrared based. These controls vary in button size and activation pressure required, but they are often similar to a garage door opener control. Most door openers incorporate a door lock as well.
Most electric hospital beds offer a variety of remote controls. Ask to see each manufacturer's control options to evaluate which may be easiest for your client to use.
Direct access EADLs aren't just for couch potatoes. Keep these easy-to-use, inexpensive devices in mind when assessing a client's self-care needs. A remote control can be just as essential as a sock aid!